Knee pain and knee injuries are extremely common among all athletes. Chronic knee pain not only affects our capability for exercise, but also intrudes on daily quality of life. And catastrophic injuries to the knee joint often require surgery with a long recovery time. Thus avoiding injury while protecting the integrity of the knee joint and its’ tissues is critical for everyone.

The four main ligaments of the knee prevent the tibia and femur from separating to the front, back, left, or right throughout the full range of motion. Other joints, such as the shoulder have a lot of muscle tissue which helps maintain the structure and stability; or the hip which has a tight ball in socket joint using bone structure to maintain joint integrity. The knee however has little protection from bone structure and the muscles above and below when engaged are all competing to move the bones in different directions. Thus the knee is prone to dislocation injuries resulting in partial or complete tears to one of the four ligaments. These devastating injuries may occur as a result of external forces such as a blow to the knee during contact, or excessive sudden muscle contraction such as when suddenly changing directions or accelerating/decelerating too quickly. This is why it is so important to stretch and warm-up properly before any activity. By adding the techniques below we can further prepare the knee for the stress forces of exercise by alerting the surrounding muscles and awakening neurological connections—thus improving proprioception and recognition of the warning signs of improper positioning.

Moderate misalignment of the knee joint may not cause immediate damage to the ligaments, but nonetheless will lead to inflammation and excessive wear and tear on the tissues of the joint.  Built up over time, this can lead to destruction of the soft tissues and chronic knee pain later in life. The structure of the knee joint and the weight bearing requirements make it impossible to totally eliminate abrasive forces to the tissues, but we should try our best to minimize them. Most of the time the ligaments do a fine job holding the knee on-track and the menisci serve well in dispersing weight and reducing friction. Unfortunately even the slightest of misalignments can lead to exponential damage to these tissues. When the joint is out of alignment weight bearing function will be excessively allocated to one side and abrasive forces will increase. This leads to inflammation, swelling and further destruction of the tissues. Most of the time rest, stretching, and treatment to reduce the inflammation are all that are necessary to recover from these type of problems, but as athletes are often unwilling to interrupt training for any extended period, injury prevention is still the best strategy.

In lesson one we learned some techniques to ready the ankle and foot bones for exercise. As these prepare the foot for weight bearing function and encourage proper positioning of the lower leg, they are also key in setting up for healthy knee alignment. In this lesson we will approach the knee from the perspective of surrounding muscles and the neurological connections which alert our body of misplacement.

As we know from Chinese medical theory and modern research, stimulation of acupuncture points along the channels that pass through the knee activate specific areas of the brain. Through use of these points we can improve speed of transmission of these signals, preparing the knee for action and keeping its’ structure secure. Additionally in the post-exercise section we will learn some techniques to loosen stiffness, reduce inflammation, and accelerate post-workout recovery.

Pre-Exercise Acupressure

The points and techniques we learned in Lesson 1 are often sufficient to align the lower leg and ready the knee for action. So please give those a try first, then add the following few points to the routine.

1. XueHai(Sp-10): This point is located on the medial side of the thigh two inches above the knee. To find it place your same side hand on your thigh, locating your middle finger so that the fingertip is positioned just below the knee cap. Your thumb should naturally fall into place on the medial side of the thigh, the tender spot you feel when you apply pressure is XueHai. To stimulate, first feel around for the most tender spot in the area and then simply apply direct pressure with your thumb. You can also massage this point in a front to back motion to help loosen the muscles which attach to the medial aspect of the knee. As this point is located on the vastus medialis muscle it helps to engage the quadriceps tendon, the medial aspect of the patella and the medial collateral ligament. Thus assisting in movement and structural stability.
2. XiYangGuan(Gb-33): This point is located just above and lateral to the knee joint. It is on the biceps femoris muscle just above the attachment to the knee. To find it use the same method as above, except use your opposite side hand this time. Place your opposite side hand on your thigh, locating your middle finger so that the fingertip is positioned just below the knee cap. Your thumb should naturally fall into place on the lateral side of the thigh. Try to feel for the tender spot, you may even be able to palpate the muscle specifically. To stimulate apply direct pressure or use an up and down massaging motion. This point helps to engage the lateral collateral ligament and the tissues which support the lateral side of the knee. By loosening the muscle and increasing postural awareness it prepares the knee for load bearing activity and impact.
3. YinLingQuan(Sp-9): This point is located on the medial side of the leg slightly below the knee and posterior to the tibia. To find it move your hand along the inner side of your leg just below your knee, try to feel the tibia bone. Moving your hand along the curvature of the bone and locate where it straightens out—that is YinLingQuan. It is also approximately four fingers breadth below the knee. To stimulate, use your same-side hand and let your thumb fall on the point while the other four fingers grasp the lateral side of the leg. This point is located on the Soleus muscle of the lower leg and is related to functioning of the foot and ankle and stability of the knee. During stimulation sensation spreads to the medial side knee joint engaging the supportive structures of the knee. (Note this was point was previously mentioned in  Lesson 1)
4. YangLingquan(Gb-34): This point is located on the lateral side of the leg just below and centered between the head of the fibula and the tuberosity of the tibia. To find this point simply slide your hand down from your knee until you feel the two bones which protrude out—these are the heads of the fibula and tibia. Draw an imaginary equilateral triangle between these points with the third point pointing downwards. This third point is YangLingQuan. Again use your thumb to apply direct pressure on this point. This point is located on the fibularis longus muscle, thus it is involved with movement of the foot and ankle as well as stability of the lateral knee joint. (Note this was point was previously mentioned in  Lesson 1)
5. WeiZhong(Ub-40): Traditionally this point is located on the exact center of the posterior knee. However in this case we will use a location slightly below the back of the knee joint. To find it simply place your thumb or finger on the back of your knee, now slide downwards toward your heel about one inch. Try to feel for the tender spot, and you’ve got it. To stimulate apply direct pressure or perform a circular massaging movement. This point engages the supportive structures and nerves of the posterior knee. It is useful for people who have a tendency for hyperextension of the knee joint or any pain which radiates down the back of the calf.
6. HeDing: This point is located just above the knee cap on the attachment of the quadriceps to the patella. To find it simply feel for the tender spot on the top edge of the center of the knee cap. Note that this point is located on a tendon so the tissue will feel much firmer. To stimulate simply apply direct pressure or use a side to side massaging motion to loosen the tendon. As this point is located on the quadriceps tendon it readies the supporting structure of the ventral knee, while also engaging the extension and flexion mechanisms of the knee. This is point is very useful for those suffering from patellar tendinitis, though in cases of tendinitis one should not massage the point but rather apply heavy direct pressure.

The above listed points provide stimulation to all aspects of the knee. Used together these points engage the muscles and supportive structures of the knee, while also increasing flexibility and awareness. Use of this pre-exercise routine helps prepare the knee for activity, both increasing performance and reducing risk of injury. Please add these six points to the techniques we learned in Lesson 1, as you feel necessary.

Post-Exercise Acupressure

Firstly your post-exercise routine should include proper cool down and stretching techniques. It is important to relax your muscles after a workout, to be sure that there is not an excessive amount of stress being placed on a specific part of the joint structure.

Below are some techniques you can add to your regular stretching routine to accelerate recovery and maintain proper alignment.

1. WeiZhong(Ub-40) and WeiYang(Ub-39): These two points are both located on the posterior side of the knee joint. WeiZhong is in the direct center of the back of the joint and WeiYang is about two inches off the center towards the lateral side. To find these two points simple bend your knee and feel for the soft spot on the back side of the knee between the two protruding tendons. To stimulate first apply direct pressure to both points followed by side-to-side and up-and-down massage. This will help move away any fluid that has built up in the knee, improve venous return, and promote local circulation.
2. MCL: Massage the medial side of the knee joint. Again bend your knee and this time feel for the joint space on the inner side of the knee (it may be helpful to continue flexing and extending the knee as you feel for the spot). This spot is at the connection of the femur and the tibia bones, there is a small space with little muscle tissue. Once you’ve found it relax your leg and use thumb or fingers to massage front to back along the joint space. This will help to relax the medial collateral ligament as well as promote local circulation.
3. LCL: Massage the lateral side of the knee joint. Use the same technique as above but on the outer side of the knee joint. In locating this spot be careful to avoid confusion with the protrusion of the fibula bone, moving the joint while feeling for the spot will help you identify clearly where the joint space is located. Again perform front to back massage. This will help to relax the lateral collateral ligament as well as promote local circulation.
4. TuBi(St-35) and WaiTuBi: These are the two concave points just below the knee cap on the sides of the patellar tendon. To find them first put your leg in a relaxed position and with your hands feel for the concave space just below the knee cap on the left and right sides of the front of the knee joint. To stimulate apply direct pressure followed by massage in a circular motion. This will help to relax the knee cap, prevent damage to the menisci by removing metabolic waste buildup, eliminate pain, and promote circulation.

Here we list only a few points and techniques as they should be used in conjunction with those of lesson one.

Wishing you strong, flexible, and pain free knees…